Questions About Alcohol and Drug Treatment in BristolMeeting 1 on 25 April 2009by Paul Hazelden

Background

Graham Donald, the chair of the board of Crisis Centre
Ministries, wrote to Stephen Williams on 25 March 2009 about some of
the problems people with addiction problems in Bristol have in
accessing treatment.

Some Basic Observations and Questions

Alcohol Addiction

There is a serious lack of funding of residential treatment for
alcoholics from Bristol.

There is no funding for a wet house in Bristol. Yet we fund the
Police to deal with the problems caused by the people who continue
to drink, and who drink in the street because there is nowhere else
for them to go.

Has anyone looked at the cost of coping with the problem of
street drinking, and compared it with the cost of providing a wet
centre?

Alcohol addiction and street drinking cost Bristol a significant
amount of money, in many different ways: policing the street
drinking ban is just one of them. If alcoholics could have direct
access to rehabs in Bristol, this would get more people off the
streets, and reduce the number of people causing a nuisance and
needing medical attention. Can we quantify this additional cost of
limited access to treatment for alcoholics?

Drug Addiction

There is a serious problem with Bristol's strategy for providing
residential treatment for drug addiction.

Bristol has a policy of sending local people in addiction only to
local residential treatment. It doesn't work because once the
treatment finishes, the addict is back in contact with the family,
friends and associates who were involved in developing and
sustaining the addiction.

It is almost impossible to stay clean if the people you associate
with (your friends and family) are using, and even more difficult if
(as is often the case) they are encouraging you to use.

This raises the obvious question: why does Bristol have this
policy? Our assumption is that it is driven by two basic concerns:

the need to save money; and

the need to support local business - the local drug treatment
providers.

In a subsequent meeting, Safer Bristol confirmed the first
point: they have a bulk purchase agreement with some local
residential drug treatment providers, which enables them to place
addicts in treatment at a lower cost, and therefore they achieve
more results for their money.

We questioned the wisdom of this strategy: it clearly achieves
more results, but does it achieve better results?
You can get more people through treatment this way, but if more of
them lapse after treatment, surely the end result is worse?

Safer Bristol made two points in their response to this challenge.

Firstly, successful treatment is defined as the addict completing
the treatment program. What happens afterwards is not relevant,
and does not affect the way their performance is measured. Their
job is to maximise treatment success, as defined by the Government,
and this is exactly what they are doing.

Secondly, we have no evidence to support our belief that more
people lapse following local residential drug treatment. Our own
observations do not count as evidence. It is mere 'anecdotal'
evidence. There have been no formal studies on this subject, so we
cannot possibly know if our claims are true.

In response to this second point: our own observations are very
clear about the different relapse rates for local and non-local
residential drug treatment, and are confirmed by the observations
of support workers from numerous other agencies. In addition, we
feel that the point is fairly obvious, and common sense strongly
supports it. And we have also been told that the European Union have
actually undertaken comparative studies of local and non-local
residential drug treament. We are in the process of trying to track
these studies down.

However, it is clear that Safer Bristol are right on one point:
our assumption that their policy must contravene the best practice
guidelines was wrong. There are, incredibly, no best practice
guidelines in the UK on this matter.

We should make two other points. One is fairly obvious, the other
a little less so.

The obvious point is that we are talking about
relapse rates - statistics - here. The policy must make sense for
the majority of the people affected by it. But the policy does not
have to treat everyone the same. A few drug addicts have helpful
and supportive families who are capable of and prepared to help
their family member get clean and stay clean. And, sometimes, that
family support is more important than the need to get the addict
away from their drug-using friends and dealers. Allowing people to
access non-local residential drug treatment is not the same as
forcing people to go to non-local treatment even when local
treatment would work better for them.

It is also the case that drug users are sometimes willing to go
to local residential treatment, and not willing to go to non-local
residential treatment. This seems less clear to us. We suspect that,
unless there is very strong personal local support, and a clear
strategy for avoiding the dealers and drug-using friends, the
majority of people in this position are willing to go through the
treatment because they know they will be able to start using again
immediately afterwards. Of course, from the point of view of the
official statistics, this does not matter: they complete the
course of treatment, and count as yet another success of the
current policy.

While there are no formal best practice guidelines, other local
authorities seem to be relying on common sense rather more than
Bristol is in this matter. Many of the people who have places in
our local residential drug treatment centres are funded by local
authorities outside Bristol.

Which brings us on to the second major consequence of this
policy: as well as producing more relapses after treatment is
complete, it also results in the number of local addicts increasing
at a greater rate than in the rest of the country.

While residential drug treatment has a higher success rate when
it is non-local, there are inevitably some relapses among the
people who come for treatment in the Bristol area.

So Bristol based drug addicts go for treatment to Bristol, and
many of them relapse. Drug addicts from outside Bristol come for
treatment to Bristol, and some of them relapse. Both groups swell
the numbers of drug addicts in Bristol.

So as well as reducing the chances of a successful outcome,
Bristol's policy also has the effect of increasing the concentration
of addicts in Bristol in comparison to the rest of the country.

We wonder if any study has been undertaken of the associated
costs of this inevitable consequence of their policy.

Some Related Observations

Housing Benefit

The policy of not paying Housing Benefit directly to landlords
results in many people getting into arrears with their rent, and
frequently the end result is that they lose the accommodation and
become homeless again.

When people are stable enough to manage their finances well,
it is entirely right to give them control over their money, and
take responsibility for paying all their bills. But to give that
responsibility to people who have no history of managing their
finances, who still have chaotic lives despite beinghoused, and
who have a high chance of lapsing back into a number of addictions,
that is just asking for problems.

Pathways

Pathways is the new centralised system for accessing Supporting
People accommodation. It is much slower than the previous system,
so people are not helped as quickly, they often develop worse
problems as a consequence, they continue in this period to access
other sources of help which the taxpayer is paying for, and the
houses have more empty places. The new system does not benefit
anyone.

Facts and Figures

It would be helpful to know some basic facts and figures.
The table below identifies a useful starting point for talking
about comparative costs for alcohol and drug treatment.

Alcohol Addiction

Drug Addiction

How many people in
Bristol are addicted?

What is their cost to the
taxpayer?

How many people were
helped in the past year?

How much do we spend on
treatment for them?

How much do we spend on
residential treatment?

We have been told on numerous occasions that this information is
'readily available' and 'in the public domain'. But, to date (as of
January 2010), we have not been given the figures.

It would also be helpful to know what Safer Bristol does, how it
reaches decisions about the various aspects of its work, what the
structures are, and who works for it. Who is responsible for what
areas and which decisions?

Finally, in passing... we have been told that Safer Bristol was
responsible for getting 152 people treated in the 2008-2009
financial year. Over the two financial years 2007-2008 and 2008-2009
CCM has managed to get something over 300 people off the streets,
at no cost to the taxpayer.